The doctors' union last night decided to order a full-blown strike next week unless the authorities implement an agreement reached late on Monday.
The strike was given the green light by the council of the Medical Association of Malta last night, sources said.
The threat comes days after half of Malta's health centres remained unmanned by doctors for a day following a dispute about the shortage of doctors in the government clinics.
When contacted, association president Martin Balzan would only say that an urgent general meeting has been set for Tuesday to discuss the strike directives which would be given at a very short notice to avoid intimidation to doctors.
The dispute between the MAM and the government reached new heights on Thursday when association officials walked out of a meeting with Social Policy Minister John Dalli. Mr Dalli had presented the doctors' representatives with options to keep all health centres open, including at night, using the present complement of 69 doctors.
This was interpreted by Dr Balzan as the government going back on the agreement reached on Monday, which stated that the Gzira health centre would no longer operate during the night and that health centre doctors would only man two out of the Gzira, Qormi, Rabat and Cospicua clinics in the afternoon.
"We are open for any discussions but Monday's agreement needs to be respected. We are not ready to renegotiate what has already been agreed upon," he said.
Mr Dalli told a press conference on Thursday the government had the right to draw up rosters and work out the different services. The revised work schedule moved doctors between shifts according to need.
In fact, according to data released by the ministry, the Mosta, Gzira, Paola and Floriana clinics, manned by between two and 3.5 doctors at night, would only need one doctor between 8 p.m. and 8 a.m.
This would allow for the number of doctors working in the seven clinics to go up by 10 in the morning hours and six in the afternoon, when they were needed most.
This would happen without adding a single doctor to the present complement.
Dr Balzan said yesterday the authorities had to give six months' notice to change doctors' working hours. "To change working hours high-handedly and unilaterally is completely against the collective agreement," he insisted.
Dr Balzan said the association had been informed that the government was considering iquidating the ongoing GP training scheme so that trainees could work in health centres.
When asked about this, a Social Policy Ministry spokesman would only say that internal discussions were still underway. Neither would he confirm a claim by Dr Balzan that farming out night services at health centres to private hospitals would cost the country €7 million a year.
Dr Balzan said that farming out services to private clinics would be a "financial black hole" and nobody would be able to control the expenditure.
The last actions by doctors on a similar scale date back to 2001 when outpatient sessions had to be cancelled and a number of health centres remained unmanned by doctors following a dispute about payments.